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Get Some Sleep: Beware the sleeping pill hangover
June 7th, 2011
04:28 PM ET

Get Some Sleep: Beware the sleeping pill hangover

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs on Tuesdays on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

Henry was 80 years old and “tired all the time.” His primary care doc had done a thorough work up. I tested for every sleep disorder known to man and god and found no underlying problem with his sleep quality.

At our initial visit, I had expressed my concern that his hypnotic medication, Clonazepam, could be part of the problem, especially because his dose of 2 mg was rather high for a man his age. He had been reluctant to make any changes to a medication that, from his point of view, had worked so well for him over the years. Now, with all other explanations ruled out, he was ready to try to get off it in order to feel less groggy in the morning.

I tapered him slowly and he had no withdrawal symptoms nor any rebound insomnia. He feels more energetic and less sleepy in the daytime and he only occasionally uses a sleeping aid when he has trouble falling asleep.

This is a scenario that is played out every day in my sleep clinic: the medications that we doctors give to help patients sleep end up making them feel tired and groggy the next day.

Clonazepam (Klonopin) is a common culprit. It belongs to a class of drugs called benzodiazepines. They have been used as sleeping agents for decades. They have many other uses including the treatment of anxiety, seizure and muscle spasm.

In general, these drugs can be very useful sleep aids, but must be used cautiously because they will often cause dependence, tolerance, withdrawal and rebound insomnia if used long enough on a nightly basis. Dependence is fairly self-explanatory and means that a person cannot sleep without the drug. Tolerance means that that the dosage has to be repeatedly increased to achieve the same affect. It is not the same as addiction but is often confused with it.

They can also cause withdrawal which means the emergence of a new set of symptoms that were not present before using the medication. Common withdrawal symptoms include agitation, nausea, sweating and palpitations.

The benzodiazepines can cause rebound insomnia. Rebound insomnia means insomnia that is worse than it was before a patient started the drug. Typically, it lasts only one or two nights.

The problem with Clonazepam in particular is that it has a very long half life. Therefore, it takes a long time to clear the system and its hypnotic and sedating effects can last well into the next day. There can be withdrawal if stopped abruptly, but it is less likely to cause rebound insomnia when compared to shorter-acting benzos.

Besides daytime sedation, any of the benzodiazepines can cause amnesia, sleepwalking and sleep eating. There are studies showing increased fall risk in the elderly, but there is also research showing that untreated insomnia increases falls. There is definite concern that these medications can have multiple deleterious effects in the elderly including memory and cognition problems. As with most medications, the doses should be lower when patients are elderly or have liver or kidney impairment.

For insomnia treatment, it is better to use benzodiazepines that have a medium half life such as lorazepam or temazepam. They will usually help someone get to sleep and stay asleep most of the night without too much hangover effect the next morning.

As with most prescription sleep aids, I recommend intermittent use so that tolerance and withdrawal might be avoided.

Medications such as zolpidem (Ambien) are called non-benzodiazepines but that is misleading because they act on the same GABA benzodiazepine receptors in the brain. They just don’t bind to as many subunits as the traditional benzos which has good and bad effects. One bad effect is that drugs like Ambien have no anti-anxiety properties and most people with insomnia have anxiety either that is fueling the insomnia or as a consequence of the insomnia.

Therefore, if someone has chronic, nightly difficulty falling asleep or staying asleep, I recommend CBT-I (cognitive behavioral therapy for insomnia). As I have discussed in previous posts, it is the safest treatment and actually the most effective one in the long term.

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Filed under: Sleep

soundoff (197 Responses)
  1. Nombre

    For anyone still wondering, please stay away from benzodiazepines. The stories are real, the danger is real, the benefits are few and far between. For those suffering and considering benzo treatment, please consider medical marijuana if it is available, or look into a combination of tea and herbs, light excersise in the early daytime and deep breathing. If anxiety comes, remember that even laying there without sleep still helps the body relax and counts for rest. That fact usually helps my brain relax if I can't sleep, and i try to meditate as i lay there to ease into sleep. As many already know, those truly suffering will try anything for relief. Just don't try benzos. They will ruin you.

    January 7, 2017 at 03:24 | Report abuse | Reply
    • cyberclark

      I am 78 years and recently became inflicted with "night terrors" which take the shape of larger purple wheels chasing me or aggressive response to something that turns out to be my headboard when I wake up. Clonazepam is the only thing prescribed by Drs. in Alberta. Apart from my own private circus about 6 hours into my sleep; it spills over to involve me attacking my wife and screaming at her in my sleep which is grossly unfair. I will check my physician on the alternatives mentioned. I think a shorter half-life will improve things.

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  12. Mario

    Eehhh, the pill is good and does not cause insomnia or withdrawal if you do not cover your ass and continue to prescribe.
    What a bunch of hooey you wrote in the article. Booo hooo, it is a benzodiazepine. So what? Yet another brainwashed “doctor” who wants an 80 year old man to go through withdrawal. Get a grip woman.

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  14. Barbara

    Taking 0.5 mg. a day nighttime actually. I sleep for 12 hours. Someone could break in and I wouldn’t know it. I was prescribed it for anxiety and seizures. It works well, but so tired in the morning to get up. perscription is 3 clonapam a day, but I only take one a night. I was told if you want to get off clonazapam go slowly...one every other day and work it down until none. Especially for my seizures

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  15. Klonopin hangover

    I have been on and off many benzos and dozens of sleep supplements and tried CBT-I too (as well as drugs for RLS and PLMD specifically). My principal issue is PLMD (and I eat well and exercise all the time) and the shaky legs have gotten so bad that I decided that the sleep deprivation and disruption caused by the PLMD is worse than the downsides of benzos I am well aware of. I am taking .5 mg. or less of Klonopin (which is the benzo of choice for PLMD as it is also an anti-convulsant), but the hangover (I just started taking it) reminds me of how I felt when sleep deprived. I know everyone is different but does any have experience with this side effect going away?

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    I have had insomnia for at least 10 years now. I also have MS. I've been on Clonazepam, 1mg for at least 6 years and benzos are the ONLY thing that has ever worked reliably. I have a stack of business cards from 'sleep specialists', all of which assume anxiety or depression first, then try to sell me on CPAP although I show NO symptoms of OSA. My main symptoms are sleep paralysis and I CANNOT FALL ASLEEP TO SAVE MY LIFE. After just a little research I find out narcolepsy is caused by the brain not producing hypocretin, a chem that regulates sleep, because it is mistakingly under attack by one's own immune system. Well, HELLO! MS is a disease where one's immune system is mistakingly attaking their central nervous system. I don't have to wonder why narcolepsy has never come up. I am fully convinced it's because it's not lucrative enough for sleep specialists, like my current one who wants to do a 5th sleep study to check for OSA. ABSOLUTELY REPREHENSIBLE

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